Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note

Abstract

<jats:p>Percutaneous endoscopic discectomy (PED) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an 8-mm skin incision. For transligamentous extruded nucleus pulposus with foraminal stenosis, it is very hard to remove the migrated mass with a simple transforaminal approach. For such difficult cases, foraminoplasty and an epiduroscopic technique is useful. A 29-year-old man visited the authors’ hospital, complaining of low-back and right leg pain. MRI revealed a massive herniated nucleus pulposus with foraminal stenosis. A transforaminal PED was planned to remove the herniated mass. Through the inside-out technique, the base of the herniated mass was removed. Following the foraminoplasty, the cannula was moved into the epidural space. With epidural observation just beneath the nerve root, the extruded transligamentous fragment was confirmed and removed en bloc. Immediately after the surgery, the patient’s symptoms resolved. The combination of foraminoplasty and epiduroscopic observation during the transforaminal approach for PED is a useful and reliable technique to remove extruded transligamentous disc fragments.</jats:p>

A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: Technical considerations in a fresh cadaver model and a literature review

“…The elderly often have comorbidities (32) rendering them at high risk for general anesthesia, so surgeries that can be done under local anesthesia are preferable in this age group. However, based on anatomic considerations, only the TF approach for foraminal stenosis has been discussed in the literature (14)(15)(16)(17). In practice, during foraminoplasty via the TF approach, we have sometimes noticed that the traversing nerve root is decompressed at the same time as the exiting nerve, due to wide removal of the superior facet joint on the cranial side ( Figure 3).…”

“…Foraminoplasty has also been reported to be effective for safe removal of an intra-canalicular herniated mass (16,17). With this procedure, the intervertebral foramen can be enlarged, allowing safe removal of the herniated mass without damage to the exiting nerve root (16,17), which is one of the recognized complications of TF surgery (18,19).…”

“…With this procedure, the intervertebral foramen can be enlarged, allowing safe removal of the herniated mass without damage to the exiting nerve root (16,17), which is one of the recognized complications of TF surgery (18,19). Essentially, this technique involves using a high-speed burr to remove the excessive bone.…”

“…Essentially, this technique involves using a high-speed burr to remove the excessive bone. Henmi et al (17) reported their experience with foraminoplasty using the high-speed burr followed by ventral epiduroscopic observation (20,21). After foraminotomy, a cannula could be inserted safely into the ventral epidural space in the neural canal.…”

Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report

“…Abe et al (21) performed foraminoplasty -the enlargement of the intervertebral foramen using an ultra-thin high-speed drill to obtain safe access to the neural canal at the lumbosacral junction-for removal of HNP. Foraminoplasty can even be used at the L4/5 level to avoid injury to the exiting nerve during surgery (14).…”